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Steroid treatment for uveitis needs strict self-regulation
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CANCUN, Mexico — Steroids can be used to effectively treat patients with uveitis if treatment is applied according to five specific rules, said Victor L. Pérez, MD, at the Pan-American Association of Ophthalmology meeting here.
"The eye cannot afford inflammation," Dr. Pérez said. "There is a fine line between the infection process and the resolution process."
Dr. Pérez presented several patient cases and discussed five rules derived from those cases.
The first case involved a patient with scleritis and keratitis, which demonstrated the need for identifying and defining whether an ocular infection exists and, if so, the proper treatment.
He noted that uveitis must be ruled out in all cases. "This will make our life easier," he said.
The second case involved a patient with a corneal ulceration after a corneal incision, which illustrated the rule that surgeons should not be afraid to use steroids, but should know when to use them. "The biggest dilemma is when to start steroids," Dr. Pérez said.
The third case involved a patient with optic nerve edema, which illustrated two rules: Patients must be closely monitored in case treatment must be stopped, and steroids can sometimes help diagnose uveitis.
The final case involved a patient who had been suffering from pain and blurred vision over 4 days. The patient also had AIDS and had been treated for pneumonia. With the possibilities of Behçet's and lymphoma, the diagnosis concluded with rifabutin-induced uveitis.
This final rule was: "Always, we have to talk to the patient and examine what is important," Dr. Pérez said.